HB 933 — Office Surgery

Section 456.073 applies to enforcement actions brought against such facilities.

If a facility's registration is revoked, the department may deny any person named in the registration documents of the facility, including the persons who own or operate the facility, individually or as part of a group, from registering a facility to perform surgical procedures pursuant to s.

458.309(3) or s.

459.005(2) for 5 years after the revocation date.

Section 2.

immediate Pagesuspension 3of license.— (6) The department may issue an emergency order suspending or restricting the registration of 18an CODING:office in which a liposuction procedure in which more than 1,000 cubic centimeters of supernatant fat is removed, a Level II office surgery, or a Level III office surgery is performed upon a finding of probable cause that the office, or a physician performing such procedure or surgery in the office, is not in compliance with the standards of practice for office surgery adopted by the boards pursuant to s.

458.328 or s.

459.0138, as applicable, or is in violation of s.

458.331(1)(v) or s.

459.015(1)(z), and that such noncompliance or violation constitutes an immediate danger to Page 3 of 11 CODING:

hb0933-02-c2hb0933-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 933 2019 suspension of license.— (6) The department may issue an emergency order suspending or restricting the registrationpublic. of a facility in which liposuction procedures in which more than 1,000 cubic centimeters of supernatant fat is removed, Level II office surgery, or Level III office surgery, as those terms are defined in ss.

458.305(8)Section and2. 459.003(9), are performed upon a finding of probable cause that the facility or its surgeons are not in compliance with the standards of practice for office surgery adopted by the boards pursuant to s.

458.309(4)Subsection or(3) s.of section 458.309, Florida Statutes, is amended to read:

459.005(3),458.309 asRulemaking applicable,authority.— or(3) areA physician who performs liposuction procedures in violationwhich more than 1,000 cubic centimeters of s.supernatant fat is removed, level 2 procedures lasting more than 5 minutes, and all level 3 surgical procedures in an office setting must register the office with the department unless that office is licensed as a facility under chapter 395.

458.331(1)(v)The department shall inspect the physician's office annually unless the office is accredited by a nationally recognized accrediting agency or s.an accrediting organization subsequently approved by the Board of Medicine.

459.015(1)(z)The actual costs for registration and thatinspection suchor noncomplianceaccreditation constitutesshall anbe immediatepaid dangerby the person seeking to register and operate the public.office setting in which office surgery is performed.

Section 458.305,458.328, Florida Statutes, is amendedcreated to read:

458.305458.328 Definitions.—AsOffice usedsurgeries.— (1) REGISTRATION.— (a) An office in thiswhich chapter,a physician performs a liposuction procedure in which more than 1,000 cubic centimeters of supernatant fat is removed, a Level II office surgery, or a Level III office surgery must register with the term:department unless the office is licensed as a facility under chapter 395.

(1)Page "Board"4 means the Board of Medicine.11 CODING:

(2) "Deep sedation and analgesia" means a drug-induced depression of consciousness during which all of the following apply:

(a) The patient cannot be easily aroused but responds by purposefully following repeated or painful stimulation.

(b) The patient's ability to independently maintain ventilatory function may be impaired.

(c) The patient may require assistance in maintaining a Page 4 of 18 CODING:

hb0933-02-c2hb0933-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 933 2019 patent(b) airway,To andregister, spontaneousan ventilationoffice maymust bedesignate inadequate.a physician who is responsible for the office's compliance with the office safety requirements of this section and rules adopted hereunder.

(d)A Thedesignated patient'sphysician cardiovascularmust functionhave isa usuallyfull, maintained.active, and unencumbered license under this chapter or chapter 459 and shall practice at the office for which he or she has assumed responsibility.

(e)Within The10 patient'scalendar reflexdays withdrawalafter fromthe painfultermination stimulusof isa notdesignated consideredphysician arelationship, purposefulthe response.office must notify the department of the designation of another physician to serve as the designated physician.

(3)(2)The "Department"department meansmay suspend the Departmentregistration of Health.an office if the office fails to comply with the requirements of this paragraph.

(4)(c) "EpiduralEach anesthesia"physician meanspracticing anesthesiaat produced by the injection of an anestheticoffice agentregistered intounder thethis spacesection on or arounds. the dura mater of the spinal cord.

(5)459.0138 "Generalshall anesthesia"advise meansthe aboard, drug-inducedin losswriting, ofwithin consciousness10 administeredcalendar bydays aafter qualifiedbeginning generalor anesthesiaending providerhis duringor whichher allpractice ofat thea followingregistered apply:office.

(a)(d) The department shall inspect a registered office at least annually, including a review of patient records, to ensure that the office is notin ablecompliance towith bethis aroused,section evenand rules adopted hereunder unless the office is accredited by painfula stimulation.nationally recognized accrediting agency approved by the board.

(b) The patient'sinspection abilitymay tobe independentlyunannounced. maintain ventilatory function is often impaired.

(c)(e) The patientdepartment hasmay depressedsuspend neuromuscularor function.revoke the registration of an office in which a procedure or surgery identified in paragraph (a) is performed for failure of any of its physicians, Page 5 of 11 CODING:

(d) The patient may require assistance in maintaining a patent airway, and positive pressure ventilation may be required.

(e) The patient's cardiovascular function may be impaired.

(6) "Minimal sedation" means a drug-induced state during which patients respond normally to verbal commands.

Although cognitive function and physical coordination may be impaired, airway reflexes and respiratory and cardiovascular functions are Page 5 of 18 CODING:

hb0933-02-c2hb0933-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 933 2019 unaffected.owners, or operators to comply with this section and rules adopted hereunder or s.

(7)459.0138 "Moderate sedation and analgesia"rules oradopted "consciousthereunder. sedation" means drug-induced depression of consciousness and a state of consciousness during which all of the following apply:

(a)If Thean patientoffice's respondsregistration purposefullyis torevoked, verbalthe commands,department eithermay alonedeny any person named in the registration documents of the office, including the persons who own or accompaniedoperate bythe lightoffice, tactileindividually stimulation.or as part of a group, from registering an office to perform procedures or office surgeries pursuant to this section or s.

(b)459.0138 Interventionsfor are5 notyears requiredafter tothe maintainrevocation adate. patent airway, and spontaneous ventilation is adequate.

(c)(f) CardiovascularThe functiondepartment ismay maintained.impose any penalty set forth in s.

(d)456.072(2) Reflexagainst withdrawalthe fromdesignated aphysician painfulfor stimulusfailure isof notthe consideredoffice ato purposefuloperate response.in compliance with the office safety requirements of this section and rules adopted hereunder or s.

(8)459.0138 "Officeand surgery"rules meansadopted athereunder. surgery that is performed in a physician's office or any facility that is not licensed under chapter 390 or chapter 395.

(a)(g) "LevelA Iphysician officemay surgery"only includesperform anya surgeryprocedure thator consistssurgery ofidentified onlyin minorparagraph procedures(a) and in whichan anesthesiaoffice that is limitedregistered towith minimalthe sedation.department.

(b)The "Levelboard IIshall officeimpose surgery"a includesfine anyof surgery$5,000 inper whichday theon patient'sa levelphysician ofwho sedationperforms isa thatprocedure ofor moderatesurgery sedationin andan analgesiaoffice orthat consciousis sedation.not registered with the department.

(c)(h) "LevelThe IIIactual officecosts surgery"of includesregistration anyand surgeryinspection inor whichaccreditation shall be paid by the patient'sperson levelseeking ofto sedationregister isand thatoperate ofthe deepoffice sedationin andwhich analgesiaa procedure or generalsurgery anesthesia.identified in paragraph (a) will be performed.

The(2) termRULEMAKING.— includes(a) anyThe surgeryboard thatshall includesadopt theby userule standards of spinalpractice anesthesiafor physicians who perform procedures or epiduraloffice anesthesia.surgeries Page 6 of 11 CODING:

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hb0933-02-c2hb0933-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 933 2019 (9)(4)pursuant "Physician" means a person who is licensed to practice medicine in this state.section.

(10)(3)(b) "PracticeThe ofboard medicine"may meansadopt rules to administer the diagnosis,registration, treatment,inspection, operation,and orsafety prescriptionof foroffices anyin humanwhich disease,a pain,physician injury,performs deformity,procedures or otheroffice physicalsurgeries orpursuant mentalto condition.this section.

(11) "Spinal anesthesia" means anesthesia produced by the injection of an anesthetic agent into the subarachnoid space of the spinal cord.

(12) "Surgeon" means a physician who performs surgery.

(13) "Surgery" means any manual or operative procedure, including the use of lasers, performed upon the body of a living human being for the purposes of preserving health, diagnosing or curing disease, repairing injury, correcting deformity or defects, prolonging life, or relieving suffering or any elective procedure for aesthetic, reconstructive, or cosmetic purposes, including, but not limited to:

incision or curettage of tissue or an organ;

suture or other repair of tissue or an organ, including a closed as well as an open reduction of a fracture;

extraction of tissue, including premature extraction of the products of conception from the uterus;

insertion of natural or artificial implants;

or an endoscopic procedure with use of local or general anesthetic.

Subsection (3) of section 458.309, Florida Statutes, is amended, and subsection (4) is added to that section, to read:

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Words stricken are deletions;

words underlined are additions.

hb0933-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 933 2019 458.309 Rulemaking authority.— (3) A physician who performs any liposuction procedure procedures in which more than 1,000 cubic centimeters of supernatant fat is removed, any Level II office surgery level 2 procedures lasting more than 5 minutes, or any Level III office surgery and all level 3 surgical procedures in an office setting must register the office with the department unless that office is licensed as a facility under chapter 395.

The department shall inspect the physician's office annually unless the office is accredited by a nationally recognized accrediting agency or an accrediting organization subsequently approved by the Board of Medicine.

The actual costs for registration and inspection or accreditation shall be paid by the person seeking to register and operate the office setting in which office surgery is performed.

As a condition of registration, a physician who performs surgical procedures in an office setting, and the office itself if it is a separate legal entity from the physician, must maintain the same levels of financial responsibility required in s.

458.320.

(4)(a) The board may adopt rules to administer the registration, inspection, and safety of offices in which a physician performs office surgery.

(b) As a part of registration, such an office must designate a physician who is responsible for the office's compliance with this section and the rules adopted hereunder.

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words underlined are additions.

hb0933-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 933 2019 Within 10 days after termination of the designated physician, the office must notify the department of the identity of another designated physician for that office.

The designated physician must have a full, active, and unencumbered license under this chapter or chapter 459 and shall practice at the office for which he or she has assumed responsibility.

The department may suspend a registration certificate for an office without a designated physician who practices at the office.

(c) The department shall inspect the office at least annually, including a review of patient records, to ensure that it complies with this section and rules adopted hereunder unless the office is accredited by a nationally recognized accrediting agency approved by the board.

The inspection may be unannounced, except for the inspection of a physician's office that meets the description of a clinic specified in s.

458.3265(1)(a)3.h., which must be announced.

(d) The board shall adopt by rule standards of practice for physicians who perform office surgery.

The board shall impose a fine of $5,000 per day on a physician who performs a surgical procedure identified in subsection (3) in an office that is not registered with the department.

Section 5.

action by the board and department.— Page(1) 9The following acts constitute grounds for denial of 18a CODING:license or disciplinary action, as specified in s.

Words stricken are deletions;

words underlined are additions.

hb0933-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 933 2019 (1) The following acts constitute grounds for denial of a license or disciplinary action, as specified in s.

458.309(3).458.328 or s.

Section459.0138. 6.

Section 459.003,5. Florida Statutes, is amended to read:

459.003Subsection Definitions.—As(2) usedof insection this459.005, chapter,Florida theStatutes, term:is amended to read:

(1)459.005 "Board"Rulemaking meansauthority.— the(2) BoardA physician who performs liposuction procedures in which more than 1,000 cubic centimeters of Osteopathicsupernatant Medicine.fat is removed, level 2 procedures lasting more than 5 minutes, and all level 3 surgical procedures in an office setting must register the office with the department unless that office is licensed as a facility under chapter 395.

(2)The "Deepdepartment sedationshall andinspect analgesia"the meansPage a7 drug-induced depression of consciousness11 duringCODING: which all of the following apply:

(a) The patient cannot be easily aroused but responds by purposefully following repeated or painful stimulation.

(b) The patient's ability to independently maintain ventilatory function may be impaired.

(c) The patient may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate.

(d) The patient's cardiovascular function is usually maintained.

(e) The patient's reflex withdrawal from painful stimulus is not considered a purposeful response.

(3)(2) "Department" means the Department of Health.

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hb0933-02-c2hb0933-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 933 2019 (4)(5)physician's "Doctoroffice ofannually Osteopathy"unless andthe "Doctoroffice ofis Osteopathicaccredited Medicine,"by whena referringnationally torecognized degrees,accrediting shallagency beor construedan toaccrediting beorganization equivalentsubsequently andapproved equalby degrees.the Board of Osteopathic Medicine.

(5)The "Epiduralactual anesthesia"costs meansfor anesthesiaregistration producedand byinspection theor injectionaccreditation ofshall anbe anestheticpaid agentby into the spaceperson onseeking orto aroundregister and operate the duraoffice matersetting ofin thewhich spinaloffice cord.surgery is performed.

(6)Section "General6. anesthesia" means a drug-induced loss of consciousness administered by a qualified general anesthesia provider during which all of the following apply:

(a)Section The459.0138, patientFlorida Statutes, is notcreated able to beread: aroused, even by painful stimulation.

(b)459.0138 TheOffice patient'ssurgeries.— ability(1) toREGISTRATION.— independently(a) maintainAn ventilatoryoffice functionin which a physician performs a liposuction procedure in which more than 1,000 cubic centimeters of supernatant fat is oftenremoved, impaired.a Level II office surgery, or a Level III office surgery must register with the department unless the office is licensed as a facility under chapter 395.

(c)(b) TheTo patientregister, hasan office must designate a levelphysician who is responsible for the office's compliance with the office safety requirements of depressedthis neuromuscularsection function.and rules adopted hereunder.

(d)A Thedesignated patientphysician maymust requirehave assistancea infull, maintainingactive, aand patentunencumbered airway,license under this chapter or chapter 458 and positiveshall pressurepractice ventilationat maythe beoffice required.for which he or she has assumed responsibility.

(e)Within The10 patient'scalendar cardiovasculardays functionafter maythe betermination impaired.of a designated physician relationship, the office must notify the department of the designation of another physician to serve as Page 8 of 11 CODING:

(7) "Minimal sedation" means a drug-induced state during which patients respond normally to verbal commands.

Although cognitive function and physical coordination may be impaired, airway reflexes and respiratory and cardiovascular functions are unaffected.

(8) "Moderate sedation and analgesia" or "conscious Page 11 of 18 CODING:

hb0933-02-c2hb0933-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 933 2019 sedation" means a drug-induced depression of consciousness and a state of consciousness during which all of the followingdesignated apply:physician.

(a) The patientdepartment respondsmay purposefullysuspend toa verbalregistration commands,for eitheran aloneoffice orif accompaniedthe byoffice lightfails tactileto stimulation.comply with the requirements of this paragraph.

(b)(c) InterventionsEach arephysician notpracticing requiredat toan maintainoffice aregistered patentunder airway,this andsection spontaneousor ventilations. is adequate.

(c)458.328 Cardiovascularshall functionadvise isthe maintained.board, in writing, within 10 calendar days after beginning or ending his or her practice at the registered office.

(d) ReflexThe withdrawaldepartment fromshall inspect an office at least annually, including a painfulreview stimulusof patient records, to ensure that the office is notin consideredcompliance with this section and rules adopted hereunder unless the office is accredited by a purposefulnationally response.recognized accrediting agency approved by the board.

(9)The "Officeinspection surgery"may meansbe aunannounced. surgery that is performed in a physician's office or any facility that is not licensed under chapter 390 or chapter 395.

(a)(e) "LevelThe Idepartment officemay surgery"suspend includesor anyrevoke surgerythe thatregistration consists of onlyan minoroffice proceduresin andwhich a procedure or surgery identified in whichparagraph anesthesia(a) is limitedperformed for failure of any of its physicians, owners, or operators to minimalcomply sedation.with this section and rules adopted hereunder or s.

(b)458.328 "Level II office surgery" includes any surgery in which the patient's level of sedation is that of moderate sedation and analgesiarules oradopted consciousthereunder. sedation.

(c)If "Levelan IIIoffice's officeregistration surgery"is includesrevoked, the department may deny any surgeryperson named in which the patient'sregistration leveldocuments of sedationthe isoffice, thatincluding the persons who own or operate the office, individually or as part of deepa sedationgroup, andfrom analgesiaregistering an office to perform procedures or generaloffice anesthesia.surgeries pursuant to this section or s.

The458.328 termfor includes5 anyyears surgeryafter that includes the userevocation ofdate. spinal anesthesia or epidural anesthesia.

(10)(4)(f) "OsteopathicThe physician"department meansmay aimpose personany whopenalty isset licensedforth to practice osteopathic medicine in thiss. state.

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hb0933-02-c2hb0933-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 933 2019 (11)(3)456.072(2) "Practiceagainst of osteopathic medicine" means the diagnosis,designated treatment,physician operation, or prescription for anyfailure humanof disease,the pain,office injury,to deformity,operate or other physical or mental condition, which practice is based in partcompliance uponwith educationalthe standardsoffice andsafety requirements which emphasize the importance of thethis musculoskeletalsection structure and manipulativerules therapyadopted inhereunder theor maintenances. and restoration of health.

(12)458.328 "Spinaland anesthesia"rules meansadopted anesthesiathereunder. produced by the injection of an anesthetic agent into the subarachnoid space of the spinal cord.

(13)(g) "Surgeon"A meansphysician may only perform a physicianprocedure whoor performssurgery surgery.identified in paragraph (a) in an office that is registered with the department.

(14)The "Surgery"board meansshall anyimpose manuala orfine operative procedure, including the use of lasers,$5,000 performedper uponday theon body of a livingphysician humanwho beingperforms fora theprocedure purposes of preserving health, diagnosing or curingsurgery disease,in repairingan injury,office correctingthat deformityis ornot defects,registered prolongingwith life,the ordepartment. relieving suffering or any elective procedure for aesthetic, reconstructive, or cosmetic purposes, including, but not limited to:

incision(h) orThe curettageactual costs of tissueregistration and inspection or anaccreditation organ;shall be paid by the person seeking to register and operate the office in which a procedure or surgery identified in paragraph (a) will be performed.

suture(2) orRULEMAKING.— other(a) repairThe ofboard tissueshall oradopt anby organ,rule includingstandards aof closedpractice asfor wellphysicians aswho anperform openprocedures reductionor ofoffice asurgeries fracture;pursuant to this section.

extraction(b) ofThe tissue,board includingmay prematureadopt extractionrules ofto administer the productsregistration, inspection, and safety of conceptionoffices fromin thewhich uterus;a physician performs procedures or office surgeries pursuant to this section.

insertion of natural or artificial implants;

or an endoscopic procedure with use of local or general anesthetic.

Subsection (2) of section 459.005, Florida Page 13 of 18 CODING:

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words underlined are additions.

hb0933-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 933 2019 Statutes, is amended, and subsection (3) is added to that section, to read:

459.005 Rulemaking authority.— (2) A physician who performs any liposuction procedure procedures in which more than 1,000 cubic centimeters of supernatant fat is removed, any Level II office surgery level 2 procedures lasting more than 5 minutes, or any Level III office surgery and all level 3 surgical procedures in an office setting must register the office with the department unless that office is licensed as a facility under chapter 395.

The department shall inspect the physician's office annually unless the office is accredited by a nationally recognized accrediting agency or an accrediting organization subsequently approved by the Board of Osteopathic Medicine.

The actual costs for registration and inspection or accreditation shall be paid by the person seeking to register and operate the office setting in which office surgery is performed.

As a condition of registration, a physician who performs such surgical procedure in an office setting, and the office itself if it is a separate legal entity from the physician, must maintain the same levels of financial responsibility required in s.

459.0085.

(3)(a) The board may adopt rules to administer the registration, inspection, and safety of offices in which a physician performs office surgery.

(b) As a part of registration, such an office must Page 14 of 18 CODING:

Words stricken are deletions;

words underlined are additions.

hb0933-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 933 2019 designate a physician who is responsible for the office's compliance with this section and the rules adopted hereunder.

Within 10 days after termination of the designated physician, the office must notify the department of the identity of another designated physician for that office.

The designated physician must have a full, active, and unencumbered license under this chapter or chapter 458 and shall practice at the office for which he or she has assumed responsibility.

The department may suspend a registration certificate for an office without a designated physician who practices at the office.

(c) The department shall inspect the office at least annually, including a review of patient records, to ensure that it complies with this section and rules adopted hereunder unless the office is accredited by a nationally recognized accrediting agency approved by the board.

The inspection may be unannounced, except for the inspection of a physician's office that meets the description of a clinic specified in s.

459.0137(1)(a)3.h., which must be announced.

(d) The board shall adopt by rule standards of practice for physicians who perform office surgery.

The board shall impose a fine of $5,000 per day on a physician who performs a surgical procedure identified in subsection (2) in an office that is not registered with the department.

Section 8.

Page459.015 15Grounds offor 18disciplinary CODING:action;

action by the board and department.— Page 10 of 11 CODING:

hb0933-02-c2hb0933-03-c3 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HBCS/CS/CS/HB 933 2019 459.015(1) GroundsThe following acts constitute grounds for denial of a license or disciplinary action;action, as specified in s.

action by the board and department.— (1) The following acts constitute grounds for denial of a license or disciplinary action, as specified in s.

459.005(2).458.328 or s.

Section459.0138. 9.

ParagraphSection (a)8. of subsection (1) of section 766.101, Florida Statutes, is amended to read:

766.101 Medical review committee, immunity from liability.— (1) As used in this section:

(a) The term "medical review committee" or "committee" means:

1.a.

A committee of a hospital or ambulatory surgical center licensed under chapter 395 or a health maintenance organization certificated under part I of chapter 641;

b.

A committee of a physician-hospital organization, a provider-sponsored organization, or an integrated delivery system;

c.

A committee of a state or local professional society of health care providers;

d.

A committee of a medical staff of a licensed hospital Page 16 of 18 CODING:

Words stricken are deletions;

words underlined are additions.

hb0933-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 933 2019 or nursing home, provided the medical staff operates pursuant to written bylaws that have been approved by the governing board of the hospital or nursing home;

e.

A committee of the Department of Corrections or the Correctional Medical Authority as created under s.

945.602, or employees, agents, or consultants of either the department or the authority or both;

f.

A committee of a professional service corporation formed under chapter 621 or a corporation organized under part I of chapter 607 or chapter 617, which is formed and operated for the practice of medicine as defined in s.

458.305 s.

458.305(3), and which has at least 25 health care providers who routinely provide health care services directly to patients;

g.

A committee of the Department of Children and Families which includes employees, agents, or consultants to the department as deemed necessary to provide peer review, utilization review, and mortality review of treatment services provided pursuant to chapters 394, 397, and 916;

h.

A committee of a mental health treatment facility licensed under chapter 394 or a community mental health center as defined in s.

394.907, provided the quality assurance program operates pursuant to the guidelines that have been approved by the governing board of the agency;

i.

A committee of a substance abuse treatment and education prevention program licensed under chapter 397 provided Page 17 of 18 CODING:

Words stricken are deletions;

words underlined are additions.

hb0933-02-c2 F L O R I D A H O U S E O F R E P R E S E N T A T I V E S CS/CS/HB 933 2019 the quality assurance program operates pursuant to the guidelines that have been approved by the governing board of the agency;

j.

A peer review or utilization review committee organized under chapter 440;

k.

A committee of the Department of Health, a county health department, healthy start coalition, or certified rural health network, when reviewing quality of care, or employees of these entities when reviewing mortality records;

or l.

A continuous quality improvement committee of a pharmacy licensed pursuant to chapter 465, which committee is formed to evaluate and improve the quality of health care rendered by providers of health service, to determine that health services rendered were professionally indicated or were performed in compliance with the applicable standard of care, or that the cost of health care rendered was considered reasonable by the providers of professional health services in the area;

or 2.

A committee of an insurer, self-insurer, or joint underwriting association of medical malpractice insurance, or other persons conducting review under s.

766.106.

Section 10.

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